Despite tremendous improvements in the early detection of breast cancer and related long-term survival, certain groups of women, including rural Appalachian women, continue to experience a disproportionate burden of disease. This dissertation seeks to understand how older, rural women from an underserved area of Appalachian Kentucky develop knowledge and beliefs about cancer in general and, in particular, breast cancer, over the life course and how beliefs shape the use of cancer screening services. Since existing literature demonstrates that health beliefs influence the uptake of health services, it is essential that we improve our understanding of the development and nature of cancer health beliefs. Previous quantitative studies have not been able to capture the experience or thoroughly explain why certain women do not receive cancer screenings. Use of qualitative methods, grounded theory in particular, will allow the researcher to explore underlying beliefs and meanings in an in-depth and contextualized manner. Using theoretical sampling, approximately 20 women ages 55 and older without a history of cancer diagnosis will participate in the study. Each woman will be interviewed approximately three times each due to the in-depth nature of the interview guide. While grounded theory will shape the project, we draw on the Health Belief Model, the Common Sense Model of Illness, and Anderson's (1995) Health Behavior Model to focus the research questions. Questions assess the perceived availability of health resources, health and cancer beliefs, knowledge of cancer and breast cancer screenings, and mammography, self-breast exam, and clinical breast exam thoughts and behaviors. After transcription, each interview will undergo coding and thematic analysis using NVivo 7 qualitative analysis software. Results from this study will be used to initiate a long-term focus on underserved rural populations and challenges to health service utilization. This research project seeks to enhance access to cancer services through learning more about the barriers older women in an underserved area experience, a goal consistent with the priorities of AHRQ. Indeed, the selected county falls under the Appalachian Regional Commission's "distressed" status due to the high poverty rates, low per capita income, and high rates of unemployment in the county. In addition, the sample included in the study represents identified "priority populations": elderly, rural, low-income, and women. Finally, the study begins work toward eliminating cancer disparities and reducing cancer illness and death, the two Healthy People 2010 goals, by identifying beliefs, meanings, and screening barriers among this underserved and disproportionately affected population of women. [unreadable] [unreadable] [unreadable] [unreadable]